HomeMy WebLinkAbout15459 - �� CITY OF DIAMOND BAR /
_, DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �r
21660 E.Copiey Drive Suite 190
(909)86(1-3195 Fa�c(909)861-3117 � PRESS
����� BUII.DIIVG PERMTT APPLICATION FIRMLY
Q ADDRESS f 3O���FCAJ 1Yc�U� DATECATION� 5 (/v NUMB R��N/C
$ ISSUE � TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER �Q F�G JUF�L��
o ADDRESS V lV ZONING SETBACKS
"' CITY pit�teylp �3�41L _ ZIP l�,� TE �! 31 � 2I FRONT RW ❑
� APPUCANT � l /� 1 F•�t 5 T REAR ❑
" SIDE/SIDESTREET RW 0
� CONTRACTOR M I I��1,�(�nf.7 SIDE O
ADDRESS �
� CfTY G{C-UG..eGCTY 7ap q�z32 TE U PROPOSED USE
� ARCFUENG! •
k(o/:
DESIGNER NO.DWEL NO. NO.
ADDRESS UNITS STORIES BEOROOMS
� CITY ZIP TEL
�
y DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANAIUATION
p� OWNER•BUILDER DECLAFiATION SFWADDlREM
O
. p I MEREBY AFFIRM UN�ER PENKTT OF PEFLVHY THAt I MI E%EMVT FHOM THE COD(TAACTORS LL Gd18gB/CdfpOR
llJ CEHSFUWF01iiNEFOLLOWWURFA$ONISEC70]t.6BU51NESSANDPPOFESSqNSGODE:ANYpTYOR (n .
C7 �{p((YW�IILNqEq/WE$APERMITTOWNSTRUCi.AL7EF�Y1PflOY�DEMOLISH,ORRE7NHM11'STiX1C. W
�?� 1URE,PwOFi TO IT8 IS9UANCE,A150 REOUIitES iHE MDIICNlT FOq SUCH VEMUT TO FILE A SIGNED W PatiolDeck
STATFYENi TN�i NE O(i SME IS 110EN5ED PUftSuuli TO iME PROVISIONS OF THE GONTRACTORS LF
� CENSE U1V(CNAPTEN�ICOMMENCWO NATH 6ECTqN 7oD0)OF OIVI510H 7 OF THE BUSINE55 HJD PRD LL POO�SP2
FESSDNS COOE1�R 1MAT XE Oit L1E IS EIlEl1PT TMEREFROM AND THE BA515 FOFi THE ALLEGED E7cEMV-
T10N.ANVVIOUTpNOFSECTqNIWf.6BYAN'IAPPIIL�HiFO1tAPERMIT5U8JECTbiHEMPLIGNTTO Z R@-ROO�
',., AtlYILiENALT/OFNDTNORETWWFIYEMUNORED00UAR51i5001.1: .
� O1�30vMEROFME�iqGFRTV,OiiMVEArPIOVEE5W17HWAGE5A5THEui50lFCOA1PEN5ATqN, � Lpmmefti2l '
WILI DO iHE WOfYC,ANO iHE STAUCTURE LS fqT WTEIDEO OR OFFEf1ED FOR SALE(SEG 70M.BU54 J
� NESb AIA PROFESSIONS CODE iHE COHT(iACTOfiSIIGENSf lAW DOES NDT ADPIY TO AN OWNER OF ?
VROPEAiYYIliDBUIDSOfiM71i0YE5TNEREOf1.M10WMODOE55UCl/YARKIUMSELFORHERSELFOR m
.. . � iMnOUGHW3011HEqOWNfMPLOYEES.PROVIDEDTHAT5tKJ1wPpOVEA1ENiSMENOTINTENDE00q
l�1 OFGFRmWNSAIEIF.IqWEVERiHE^�"•�.••,•ORIMAROYE►IINTLSSIXDWfiMNONEYEAROFCOYPLE.. .. .�. - . . -_ - - - -. .. .... . . . . - .. .
Z TqN.iME OWNER-BUILDEi1 YAl1 FNVE h1E BUR�EN OF PFIOVWO THAi HE OR 6HE DiD NOT BULLD OR - . . . _ . ___ '_ _ .
= WPNOYEFONiHFM1HPO5EOF5ALE�
W ❑I�ONMEROFTMEPROCERTV./JIEXGLU5IYELYCOMqACTNONTiHtJCEN5E0GflNTMCTOR4
� TO C11f1SiiLL1CT TME DH6IECT(SEG 70M,BUSINE55 ANO PRDFESSIONS CODE 7NE CONiRACTOiiS L4 Valwtbn /1�J.Afl�
iti CEN,sEUW00ESNOTMPIYTOANOVMEROFAPRODER1YYhqBUL0.SOAWPPOVESTNEREON.AND
� vmomHriucrscoasuo�vaniEcrsxnnucornw�croWs���cwsmvuRwu�rron+Econrw�c OUANTITY DESCRIPTION FEE
. � �iOfLSUGEt+SEUW} .
OIAME%ELPTUNDERSEC. B.iP.GFOfiiWSftEASON U
li� �
M7E ONMER V
� LICENSED CONTRACTORS DECIAfiAT10N �
� w
1 HEREBYAFFWM UNDER PE W�LTY�F VEiWHY 7FUT I AM LICENSED UNDER OROV�SiONS OF CHMTFR ,r c I
s �ICOUYENGNOWITNSECTION7oo0)OFOMSiON]OFIHEBUSIHESSMIDPROFESSIONSCAOE.ANO Z � � f�i�T �
� X YY UCENSE IS N FU.L fORCEAND EFfECL ^ �� ��r
o �� C3lo �.No.�3`I�l17o � �
�
� o,,tE S o c«+tFucr«�lil�'F��.1t..dyD a
- � WORKERS'CAMPENSATIONDECLAFiATiON Q
� INEAEBYAFFIHMtA�ERPENALTYOFPERAIRYONEOFTMEFOLIOM�uxiDECUMTqNS U
� Z
� _IlNVEANDWILlWW11AWACERiIFIUiEOFCON..ENTTOSELF•INSUREFORYAiLCERS' 2
� COYPENSATqN,AS DROVIDEO BY bEGT10N 71D00F iHE LABOq COOE FOR THE DERFOFlYANCE W
OF TF1E WOfiK FOR YAfICN THIS VEPW T IS ISSUFD. �
�
'� ,�1lMVEM/DN7LLMAMiA1NMqRKERS'COMPENS�iqNINSURANCEASREOUIREDBVSECiqN
O �70o OF TME IABOfi COOE FOH TME iERFOfJAANGE OF THE wOF1K FOR M7fIGH TMIS PEWAIT IS
� 63UFD.yy��/TOO�DENSATqNWSURANCECAHR:ERAHDPOUCYNUMeERME C•ON$TRUCTI�N
� u,pqiEp �.. PIAtJ REVIEW
� �o,�,�o�o �.�e_�os 5r�� � E�crwc
w fniSSECra+r�HOTBE�.PIEimociVfaw,�iBwaov¢�umnootursR�ao�on�Fss} PLUMBING ���.• ��r.a
• r_�
Z ICENi1FYTUi1NTNEPERFO�'WANGEOFTMENGFKFORNMiOfTWSPEFWiT{SISSUED.1 MECHANICAL -�. � -
(•} SMALL NOT EIAPLOY ANV PEFi50N N INv wNNER SO AS TO BECO�.�E SUBJEM TO iHE
N wOHI(ERS'Gq1PEN5ATqNUw50FGWFORNiAN+DAGfiEE7M�TIFISHOIADBECOME INSPECTIONFEE
SUBJEGTTOiHEHfOFLCERS'COMPENSATIONPROVi5fON5 FS ilONa7ooOFTHEUBOR
�j cooE ir n�wm�caua�r wmf tras v i++s. ISSUANCE ��yII
pD�iE: J O ��l�c�ut: SMIP Ph��v
� ENERGY P/C ZA 1
WARIIINO:FAILUPEiOSEWREWORKERS'COMPENSAT COVERAGEISUNLAWFULANDSF/AIIBE /,�j�
� SU6IECTANEIIPLOYFATOCRIAAPULGENKTIESMIDCMLFWESUPTOONEI0.R�DRE�7/10USMlD ENERGYPERMIT �71iTi �i HA�+�
DOUAFi51f1oo.0ooG W IDDITiON TO iHE COST OF COMPENSATqN.DAMAGES AS PROVIDED FOR W —II
QSECTqN1taOFTHEUeORCODE,WTEREST,ANO111TDRNEY5FEE5. p��ONFEE:
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� INEREBYAFFiRMUNDEHiENAIiYOFPERRJFY7NATTNERE45ACONSiRUGTpNLENDwGAGENCV �
FOR THE PERFOR�ANGE OF TNE WORK FOR WHIG1 THIS DEAIAIT IS ISSUED(SEG 70Y1.GY.G�.
�
� LENDER'SN.uAE
� LENOER'SADOFESS
� ICERTIGYTNATIHAVEREADTH�SADVL1GifONINDSTAiETHATTHEABOYEWFORAIATIONISCOfiHECL TOTALFEES
� IAGREEtOCOMPlYYA7HALLGTYANDGOIR�NORDWANCCSANOSTA7EUN5REUTWOTOBUILDWO
CONSiRUCT10N,AND HEREBY AUTFIDRIZE REPFESENTATIYFS OF T111S GOUNTY TO Ei1TEH UPON TME
Z �ove.e�¢rrtioneovroveRnwauuvEcranvuarosEs. COMMENTS
9 , LF.�w�S
m PERMii7EE -
4 ( Oa
�
Uj SM.NATU OFP TE
� RECPL N0. PAID BY VAUDATION
WHITE--DepaRment Copy,YELLOW—fnence Copy.PINK—Assessor Cop�,GOLDENR06—Fiie Copy,GREEN—ApWicanfs Copy
� � i � � ►
r , � � �
� � ���: - _ - - , -
� :�7:����
n�,�� .
,; E��.i _,
� ���k; ; - - -
,�;
�� � , _ ._
� -
; , � z -
'. � O c -
- �' � F.�; p F- W . ' • .
• ��':� , Q J
�/ Q (] �� __ � Q p o � g � �y � Z
m �.. '�,I, ❑ c� � zmQia zzU �y vi ¢ z " � ;��-
O �I,F cn p Q � m o w m c7 0 � Z n. cn vi c? F Q
❑ U u� r- zmo ? < � Uv � gz u7a � LLaa. ^,�:
.. � W ���'i Q � o o U ��o � z o C7 � ¢ w z ¢ o C7 a- � z H � v, ,.
, � C3 u"'. u. d m z O ¢ z � � � w Z W F- z Q O °- � �L >- c
O Q �.�'.C L w ¢ fL g J � O Cf1 CL = 2 W LL li F- d W V W N W .L W �
� �.�p w w a a = m � C 7 V C3 � � J J tA U .� o ~ � � � u- � -
`�'- � Q E � � W W � ¢ tii Z � O O O u. � < � q � ¢ > w "`i
' d O ':i� xz z � � � zcrwoZ000u- wz zzfrw w z'
- ' 0 �LL u. � � � u. � m � a_ m ¢ u. d a n. O o � dJ o u. u. x o w �-�i
ti U "
W
7
i:. O 0. I, %
, >- N � i_ —
. V ` }�{�_- =�
_ '�Tr�� =,} I ✓
�",;
� . .,�41I � %; ' , . i
r.- r~t�� � � �� ; ` � _ -
, . �;���' " �I.' �.
. I �..1� ��' " . _ . �!�.i
, . _ Z , .' I�1�. . ..
.. �� -: . O . .. . • ��
-r..�^ � O � U Z a � � ¢ 2 W Z O g Z U `� � (n N � . , � i
F- Z m F-
� U' 0[ z) � _ YUJ .Y
�"�I [n � � ty,� ¢ > F- Z � E" U � m 0 ~Q � Q Y F' M= Z � h ' , .
��'�q � (,7 J p W Q C W W Q W � � � J UJ Z Z -� (J� � V- G� .R� ' ' ���.
,.��'N Y [C (j a Q �i W W G�' ? S W d � 2 = 2 ...1 '� J H 7 E W �� ll.l ' F�¢-F' ". } � � �i-
1 U O � ¢ O u> S C7 O F cn � !- F_ �O W J � . .
� ' *1�(,d m � F" ,�j � a � u'.. � LL c=7 t=.'s C�7 W � Z z a ¢ U a a �� x w a. 5_ U d . �- y:
Q, W � J W `t J J J J �
� =�� � w o m � �- oa o » � or_ 'J =� � saw u� a T a � t=a. .
cr"i� � w � vgir � � � Q � � � � w ? voc"'i� uWic"'i� � iiu.�ul��' . � mtwn W_��� ' �i,
�